Provider Demographics
NPI:1518967835
Name:FROCILLO, CHRISTOPHER J (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:FROCILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-0187
Mailing Address - Country:US
Mailing Address - Phone:586-727-5840
Mailing Address - Fax:586-727-5897
Practice Address - Street 1:66707 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MI
Practice Address - Zip Code:48050-2019
Practice Address - Country:US
Practice Address - Phone:586-727-5840
Practice Address - Fax:586-727-5897
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4537946Medicaid
MI0N74950001Medicare ID - Type Unspecified
MIG89722Medicare UPIN